Anterior Cruciate Ligament Injury Research Articles

Automatic Segmentation of Quadriceps Femoris Cross-Sectional Area in Ultrasound Images: Development and Validation of Convolutional Neural Networks in People With Anterior Cruciate Ligament Injury and Surgery

ObjectiveDeep learning approaches such as DeepACSA enable automated segmentation of muscle ultrasound cross-sectional area (CSA). Although they provide fast and accurate results, most are developed using data from healthy populations. The changes in muscle size and quality following anterior cruciate ligament (ACL) injury challenges the validity of these automated approaches in the ACL population. Quadriceps muscle CSA is an important outcome following ACL injury; therefore, our aim was to validate DeepACSA, a convolutional neural network (CNN) approach for ACL injury. MethodsQuadriceps panoramic CSA ultrasound images (vastus lateralis [VL] n = 430, rectus femoris [RF] n = 349, and vastus medialis [VM] n = 723) from 124 participants with an ACL injury (age 22.8 ± 7.9 y, 61 females) were used to train CNN models. For VL and RF, combined models included extra images from healthy participants (n = 153, age 38.2, range 13–78) that the DeepACSA was developed from. All models were tested on unseen external validation images (n = 100) from ACL-injured participants. Model predicted CSA results were compared to manual segmentation results. ResultsAll models showed good comparability (ICC > 0.81, < 14.1% standard error of measurement, mean differences of <1.56 cm2) to manual segmentation. Removal of the erroneous predictions resulted in excellent comparability (ICC > 0.94, < 7.40% standard error of measurement, mean differences of <0.57 cm2). Erroneous predictions were 17% for combined VL, 11% for combined RF, and 20% for ACL-only VM models. ConclusionThe new CNN models provided can be used in ACL-injured populations to measure CSA of VL, RF, and VM muscles automatically. The models yield high comparability to manual segmentation results and reduce the burden of manual segmentation.

The Relationship Between Exogenous Testosterone Use and Risk for Primary Anterior Cruciate Ligament Rupture.

In the United States, testosterone therapy has markedly increased in recent years. Currently, there is a paucity of evidence evaluating the risk of ligamentous injuries in patients taking testosterone replacement therapy (TRT). The purpose of this study was to quantify the association between TRT and the incidence of anterior cruciate ligament (ACL) injuries and the subsequent risk of ACL reconstruction (ACLR) failure. It was hypothesized that individuals receiving TRT would demonstrate an increased risk for index ACL injury and ACL rerupture. Cohort study; Level of evidence, 3. This is a retrospective cohort study utilizing the PearlDiver database. Records were queried between 2011 and 2020 for patients aged 18 to 59 years who filled a testosterone prescription. A matched control group based on age, sex, Charlson Comorbidity Index, tobacco use, diabetes, and hypothyroidism consisted of patients aged 18 to 59 years who had never filled a prescription for exogenous testosterone. International Classification of Diseases, 9th and 10th Revisions and Current Procedural Terminology (CPT) codes were utilized to identify patients with ACL injuries and those undergoing reconstruction. Multivariable logistic regression was used to compare rates of ACL injury at 6 months, 1 year, and 2 years after initiating TRT. ACLR failure was also examined at 1-year intervals for 5 years for individuals filling a TRT prescription. A total of 851,816 patients were enrolled, with 425,908 patients in the TRT and control groups, respectively. The TRT cohort was significantly more likely to experience an ACL tear during 6-month (OR, 2.66; 95% CI, 2.17-3.26), 1-year (OR, 2.46; 95% CI, 2.11-2.86), and 2-year (OR, 2.22; 95% CI, 1.98-2.48) periods. The rate of reconstruction failure did not differ between the 2 cohorts at up to 5 years of follow-up (P > .05). Patients receiving TRT were significantly more likely to sustain a primary ACL rupture but were not at a statistically significant increased risk of reconstruction failure.

Prescription Testosterone is Associated with an Increased Risk of Anterior Cruciate Ligament Injury

To characterize the relationship between testosterone replacement therapy (TRT) and anterior cruciate ligament (ACL) injuries. A retrospective cohort study using a large insurance database was conducted. Patients who were prescribed TRT for at least 3 months were matched with controls who were not prescribed TRT. Rates of ACL tears were compared between the cohorts. Multiple subgroups were created based on age (<25 years, 25-35, 36-45, 46-55, 56-65, and 65+). Multivariable logistic regressions were performed to determine the association of TRT with ACL tears while accounting for demographic variables and comorbidities. After matching, there were 160,839 patients in both the TRT cohort and control cohort. The incidence of ACL injuries was 17.8 per 10,000 person-years (95% CI: 16.4-19.2) for patients who were prescribed TRT and 4.9 per 10,000 person-years (95% CI: 4.1-5.7) for controls (p<0.001). Within 2 years of filling a testosterone prescription for at least 3 months, 572 (0.35%) patients experienced an ACL injury compared to only 157 (0.10%) controls during the same follow-up period (OR: 2.77; 95% CI: 2.26-3.42, p<0.001). When stratified by age, all groups except the <25 years of age group demonstrated significantly higher rate of ACL tears (OR 3.91-12.3, p<0.001-0.009). When separated by sex, males on TRT were 3.13 (95% CI: 2.50-3.93, p<0.001) times more likely while females on TRT were 1.94 (95% CI: 1.13-3.41, p=0.018) times more likely to experience an ACL injury compared to controls. This study found that patients prescribed at least three months of TRT had a significantly higher incidence of ACL injuries compared to controls within a two-year follow-up period. Level III, retrospective comparative study.

Evaluation of the Relative Frequency of Preinjury Activity Recovery in Anterior Cruciate Ligament Replacement Patients: A Cohort Study

Background: Anterior cruciate ligament (ACL) injury has an incidence of 0.05–0.08 per thousand. An inappropriate treatment plan could lead to articular cartilage damage and early knee osteoarthritis. Some surgical reconstruction techniques use different graft types; all of them try to restore the patient’s preinjury activity levels. The current study aims to evaluate the efficacy of ACL reconstruction (ACLR) using an autologous hamstring tendon. Materials and Methods: This is a retrospective one-center cohort study performed on consecutive patients with an ACL injury who underwent ACLR using semitendinosus and gracilis autograft. The postsurgical activity and fear were measured using Marx scale and Tampa scale of kinesophobia, respectively, during a follow-up of 18 months. Results: From a total of 76 patients included in our study, 40.8% were female. The mean age of the participants was 26.25-year-old. Five patients from those with kinesophobia (12.5%) and 34 patients from those with no-kinesophobia (94%) returned to the preinjury activity level (P value &lt; 0.001). Marx scale six months after the surgery was significantly lower than the score before the surgery, but as expected, it improved during the 18-month follow-up. Conclusion: The current study showed that kinesophobia reduces the rate of return to preinjury levels. Maybe, overcoming this fear will help these patients to reach better results. However, we suggest implementing further trials in larger sample sizes before reaching a solid conclusion.

Evaluating the Importance of Return to Sports and Hamstring Strength in a Discrete Choice Experiment for Anterior Cruciate Ligament Injury.

With emerging treatments for anterior cruciate ligament (ACL) injury, analysis of patient preferences is lacking to align clinical care and research with patient priorities. To identify patient priorities for outcomes after surgical intervention if they were to sustain an ACL tear, analyze what outcome measures influenced preferences, and determine whether patient demographics influenced preferences. Cross-sectional study. The authors screened patients aged 18 to 30 years who presented for upper extremity complaints to a single institution in 2023. Patients were excluded for current lower extremity injury or history of a knee injury requiring surgical consultation. The authors designed a discrete choice experiment through literature review of outcome measures for bridge-enhanced ACL restoration (BEAR) and ACL reconstruction (ACLR) with hamstring tendon autograft. Measures included return to sports, risk of arthritis, risk of reinjury, and hamstring strength. Patients chose surgery A (ACLR with hamstring tendon autograft) or surgery B (BEAR) and then rated the importance of each outcome measure on their selection. In total, 100 participants (36 female; mean age, 25.1 ± 4.0 years) completed the discrete choice experiment. Overall, 56.0% participated in sports and 80.0% were employed. Based on surgery choice group, there were no significant differences in sex, age, Marx Activity Scale score, sports participation, or employment status between patients who selected BEAR or ACLR with hamstring tendon autograft (all P > .361). Return to sports and hamstring strength were significant priorities for patients in procedure selection (P ≤ .011). Of the patients who selected ACLR with hamstring tendon autograft, 31.6% would not elect to undergo this procedure. In this discrete choice experiment of adults without prior ACL injury, return to sports and hamstring strength were identified as patient priorities when selecting a procedure for ACL injury. Risk of reinjury, however, was not a significant factor in procedure selection. Importantly, these priorities were maintained regardless of patient characteristics, activity level, or employment status.

Influence of Injury to the Kaplan Fibers and Anterolateral Ligament on Pivot-Shift Phenomenon in Adult and Adolescent Patients With Anterior Cruciate Ligament Injury: A Retrospective Cohort Study.

Studies have shown that Kaplan fibers (KFs) play a role in controlling anterolateral rotatory knee laxity in anterior cruciate ligament (ACL) injury. However, recent clinical studies have suggested that KF injuries are not associated with a higher-grade pivot shift in knees with acute ACL injuries. To compare the effect of KF and anterolateral ligament injury on anterolateral rotatory laxity as measured by the pivot-shift test in both adult and adolescent patients with acute ACL injury. Cross-sectional study; Level of evidence, 3. This study consisted of patients who experienced primary acute ACL tears between January 2019 and December 2021. The magnetic resonance imaging examinations and pivot-shift tests for these individuals were conducted within 14 days after injury. Variables associated with concomitant injury were included in a binary logistic regression model to evaluate risk factors of a high-grade pivot shift and a KF injury. The study included 540 patients with acute ACL tears (64 adolescent patients and 476 adults). The main risk factor for a high-grade pivot shift after acute ACL injury in adults was partial or total disruption of anterolateral ligament continuity (odds ratio [OR], 2.271; 95% CI, 1.499-3.442). In adolescent patients, the main risk factor was KF injury (OR, 19.98; 95% CI, 2.367-168.669), including edema and disruption of continuity. The main risk factor for a high-grade pivot shift after acute ACL injury differs between adolescent patients and adults: the KF injury sign in adolescent patients indicates a higher-grade pivot shift.

Is a Pre-Operative MRI Anterolateral Ligament Injury Related to Anterior Cruciate Ligament Reconstruction Failure? A Prospective Cohort Study with Minimum 5 Year Follow Up

Objectives To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed by magnetic resonance imaging (MRI) at a minimum five year follow up Methods A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (Control group) of ALL injury on preoperative MRI. Both groups underwent reconstruction of the ACL with autologous hamstrings grafts. The Lysholm and subjective International Knee Documentation Committee (IKDC) scores, KT-1000 and pivot shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury and presence of knee hyperextension were evaluated. Results A total of 156 patients were evaluated. No significant preoperative differences were found between the groups. In the postoperative evaluation, patients in the control group had a lower reconstruction failure rate (14.3% vs 4.6%; P = .049) and better clinical outcomes according to the Lysholm scores (85.0 ± 10.3 vs 92.3 ± 6.3; P &lt; .0001). Although the pivot shift was similar, KT-1000 revealed worse results for the ALL injury group (2.8 +/- 1.4 mm) compared to the control group (1.9 +/- 1.3 mm) (p = 0.00018). Patients in the ALL injury group also presented a worsening of the knee instability from two to five years according to the KT-1000 (2.4 +/- 1.6 vs 2.8 +/- 1.4; p=0.038). Conclusion Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores. Also, knee stability tends to worsen from 2 to 5 years in cases of associated ALL injury.

A New Algorithm for Extra-Articular Reinforcement in ACL Injury Based on Rotational Instability

Background: The results of surgical reconstructions of the anterior cruciate ligament (ACL) are improving with the association of extra-articular reinforcements, such as anterolateral ligament reconstruction and Lemaire tenodesis. However, ACL injury can occur through various mechanisms, and when there are valgus and external rotation of the tibia, anteromedial rotational instability (AMRI) may develop. Articular reinforcement in the anteromedial quadrant, in the topography of the anterior oblique ligament (AOL), can be an important tool for patients with ACL injury and external rotation instability. Indications: The physical examination under anesthesia in patients undergoing ACL reconstruction who are candidates for extra-articular reinforcements provides important information about rotational instability. Patients with instability in external rotation may benefit from anteromedial reinforcement in the AOL’s topography. Technique Description: We propose an algorithm to be followed in patients with ACL injury and indication for extra-articular reinforcement. Patients with a positive pivot shift, indicating internal rotation instability of the knee, should undergo anterolateral reinforcements, as well as those patients with joint hyperlaxity. The algorithm suggests performing the anterior drawer in external rotation (ADER) test. When positive in isolation, anteromedial reinforcement is indicated. When the physical examination shows both positive ADER and pivot shift, both medial and lateral extra-articular reinforcement could be performed. Results: This new type of extra-articular reinforcement, in the AOL’s topography, appears to be an important tool for improving surgical outcomes in ACL reconstructions. AMRI is a risk factor for central pivot reconstruction failure and should be investigated and treated, as proposed by the algorithm. Conclusions: Clinical examination of the ACL-injured knee, preferably under anesthesia, should include internal rotational and external rotational examination (pivot-shift and ADER tests). AMRI, when detected, should be treated, and the AOL reconstruction seems to be a good alternative. We propose a new algorithm based on rotational instability to make our extra-articular reinforcement in ACL patients. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Outcomes of cruciate ligament reconstruction on patients with associated anterolateral injury

Objectives Evaluate if there is a significant difference in isolated reconstruction of the ACL in patients with or without pre-operative associated injury of the ALL. Methods Transversal retrospective study by patient’s files analysis and LYNSHOLM and IKDC questionaries to patients with isolated reconstruction of the ACL. Results The 52 patients were separated in 2 groups: 19 with associated ALL injury and 33 without associated injury. None of the patients with associated ALL injury suffered new ACL tear, but 21,1% had injured other structures, while 6,1% of patients without associated ALL injury suffered new ACL tear and 18,2% injured another structure (p=0,544). The return to activities at the same preoperative level was observed in 60% with associated ALL injury and 72% without associated injury (p=0,309). The LYSHOLM score demonstrated a median of 81,1 points with associated ALL injury and 90,1 without associated injury, and the IKDC, 70,3 points with associated injury and 76,7% without associated injury (p=0,112). Conclusion No significant statistic difference was observed for graft injury or new lesions in other structures, satisfaction with the injured knee or subjective IKDC score. Return to activities was similar in both groups with or without associated ALL injury and the LYSHOLM subjective score demonstrated better results with significant statistical difference in the group without LAL associated injury.

Early degenerative changes are different between partial and complete anterior cruciate ligament injury and associate with joint instability in a skeletally immature porcine model

ObjectiveAnterior cruciate ligament (ACL) injuries are a major problem in the pediatric and adolescent populations. Some of these injuries are only partial; yet, there is limited data to inform clinical treatment of such partial tears. It is unknown how injury partial injury impacts long-term degenerative changes in the joint relative to complete injury. In this study, we hypothesized that partial (anteromedial (AM) or posterolateral (PL) bundle) tears would result in small levels of instability and degeneration relative to complete ACL tears and that the degree of degeneration would associate with joint instability. DesignPartial (isolated AM or PL bundle) or complete ACL injury was arthroscopically created in 3-month-old juvenile pigs. The contralateral limb served as a sham-operated control. Six months after injury, joint biomechanics was assessed along with cartilage and meniscus degeneration (via MRI, gross imaging, and histology). ResultsJoint laxity increases were minimal after PL bundle injury (difference relative to controls (confidence interval): 0.5 (-1.2-2.2) mm), minor after AM bundle injury (3.7 (2.0-5.4) mm), and major after ACL injury (15.8 (13.7-17.8) mm). Cartilage MRI T1ρ relaxation times increased minimally after PL bundle injury (-0.9 (-5.1-3.3) ms for lateral tibia), moderately after AM bundle injury (6.6 (1.7-11.4) ms), and substantially after ACL injury (10.8 (2.1-19.5) ms). Changes in meniscus volume followed a similar rank order. Degeneration was associated with the extent of joint destabilization. ConclusionsThese findings suggest that cartilage and meniscus degeneration in the skeletally immature joint are associated with joint laxity after partial and complete ACL injuries.

Impact of the COL1A1 (RS1107946) gene polymorphism on anterior cruciate ligament rupture in professional soccer players

Objectives To describe the allelic frequency of rs1107946, belonging to the COL1A1 gene in professional soccer players and compare these findings with data from continental populations described in the 1000 Genomes database, in order to evaluate the frequency of genotypes highly associated with genetic susceptibility to anterior cruciate ligament (ACL) injuries in the literature. Methods The DNA of the 38 professional soccer players was collected from oral mucosa samples. DNA extraction was performed using the PureLinkTMGenomicDNAMini Kit, according to the manufacturer's protocol. For genotyping and allelic discrimination of the selected SNP (rs1107946), real-time PCR was used with TaqMan® SNP GenotypingAssay specific probes (AppliedBiosystems, Foster City, CA, USA) on the QuantStudio 6 Flex Realtime PCR system. The MMA was consistently identified in all specimens. In 26 of 33 (82%) specimens, the MMA branched directly from the popliteal artery, while in 6, the MMA shared a common trunk with the inferior medial genicular artery (IMGA). The MMA was easily distinguishable from the superior MGA, inferior MGA, and MGA, given its direct course to the medial joint line with terminal branches to the posterior horn of the medial meniscus and deep to the semimembranosus tendon. The MMA exhibited a smaller vessel diameter relative to the genicular arteries. Results Our findings demonstrated that the frequency of the wild-type allele C was 65%, while the frequency of the mutant allele A was 45%, highlighting that despite the wild-type allele, which confers protection against the risk of ACL injury, is predominantly distributed in the sample, the mutant allele is significantly present in the individuals investigated. When comparing our findings with data from continental populations described in 1000 Genomes, we found statistically significant allelic and genotypic distributions (Student's T Test p = 0.021), demonstrating that the athletes investigated have a different genetic profile. In our findings, the individuals studied presented a statistically significant allelic frequency of the mutation when compared to the European population, inferring that the frequency of this mutation is higher in European individuals than in mixed-race individuals from Brazil. Conclusion The prevalence of the rs1107946 polymorphism of the COL1A1 gene in athletes may have an important role in the development of ACL injuries.

Anterior Cruciate and Anterior Oblique Ligament Reconstruction Using Hamstrings and Peroneus Longus’ Anterior Half Grafts

Objective: To describe the surgical technique for anterior cruciate ligament (ACL) and anterior oblique ligament (AOL) reconstruction using hamstring tendons and the anterior half of the peroneus longus tendon. Methods: The surgical technique involves the following key steps: 1. Tendon Harvesting: The semitendinosus and gracilis (STG) tendons are harvested from the injured limb or the contralateral limb in cases of prior ACL reconstruction. Additionally, a 3 cm longitudinal incision is made in the posterolateral region of the fibula to harvest the anterior half of the peroneus longus (PL) tendon, ensuring the fibular nerve is not injured. The harvested tendons form a quintuple graft, with the STG folded four times and the PL used as a fifth component. 2. Graft Preparation: The STG graft is folded to create a quadruple graft, and the PL is integrated into this without folding, forming a quintuple graft proximally. The distal portion remains single, extending the PL length. 3. Tunnel Positioning for ACL: The reconstruction involves precise anatomic positioning of the femoral and tibial tunnels. The femoral tunnel is created in the Anatomical Functional Position, as described by Jorge et al., using an outside-in technique with the Acufex Pinpoint guide (Smith &amp; Nephew). The tibial tunnel is positioned on the anteromedial surface of the tibia, ensuring optimal alignment with the femoral tunnel. 4. Femoral Tunnel for AOL: The femoral tunnel for the AOL is positioned at the medial epicondyle. Fluoroscopy is used to identify the medial epicondyle in the lateral view. A guidewire is passed through the anterior portion of the medial epicondyle, creating a tunnel under radiographic visualization to ensure correct anatomical placement of the AOL. 5. Graft Passage and Fixation: The graft is passed through the tibial and femoral tunnels using a No. 5.0 Ethibond suture. The quintuple graft occupies both tunnels, and the single PL portion remains outside the tibial tunnel until fixation. Femoral fixation is achieved with an interference screw (Biosure; Smith &amp; Nephew). After pretensioning, tibial fixation is completed with the knee in full extension. The remaining PL is passed subcutaneously on the medial side and fixed in the AOL tunnel with the knee in neutral rotation and 45 degrees of flexion. This technique ensures optimal biomechanical restoration and stability in the anterolateral and anteromedial knee compartments. Results: This technique aims to improve knee stability by addressing anterolateral and anteromedial instability, which is critical in some instances of ACL injury. Using the anterior half of the peroneus longus tendon in conjunction with hamstring tendons provides a viable, biomechanically sound option for reconstruction. Conclusion: Combined ACL and AOL reconstruction using hamstring and peroneus longus tendons is a promising technique for improving knee stability in patients with ACL injuries, particularly those with anteromedial instability. This approach may be a valuable alternative to exclusive anterolateral reinforcement in select cases.

Surgical Technique for Revision of Anterior Cruciate Ligament Reconstruction, Combined with Postero-Lateral Corner and Anterolateral Ligament Reconstruction Using the Same Femoral Tunnel for Reconstruction of These Structures

Objectives The reconstruction of the anterior cruciate ligament (ACL) is the most performed knee surgery in Brazil; consequently, the number of failures in this reconstruction has increased. Each year, the exponential rise in ACL revision surgeries is linked to undiagnosed and untreated injuries. Possible causes of failures should be assessed, including the size and positioning of femoral and tibial tunnels, neglected ligament and meniscal injuries, rotational instabilities, and axis deviations. This article aims to describe a surgical technique for revising ACL reconstruction, associated with the posterolateral corner and anterolateral ligament, using the same femoral tunnel with autograft. Therefore, the article emphasizes the importance of preoperative diagnosis and the treatment of meniscal and ligament injuries associated with ACL injury. This new technique proves to be reliable, easily reproducible, providing adequate stability, reducing the number of femoral tunnels, and minimizing the chance of tunnel convergence, utilizing autologous grafts. Methods description of Surgical Technique for Revision of Anterior Cruciate Ligament Reconstruction, Combined with Posterolateral Corner and Anterolateral Ligament Reconstruction Using the Same Femoral Tunnel for Reconstruction of These Structures. Results Patients who underwent ACL revision with the technique described presented adequate anterolateral and rotational stability, compared to other reconstruction techniques of the posterolateral corner and anterolateral ligament. Conclusion The surgical technique described above generated stability in the revision of the ACL, as it was associated with simple peripheral ligament reconstruction using autologous tendons. This new technique appears to be reliable, easy to reproduce, generating adequate stability, thus reducing the number of femoral tunnels and the chance of confluence of these tunnels.

A systematic review about strategies to reduce kinesiophobia after Anterior Cruciate Ligament Reconstruction (ACLR)

Objectives Anterior Cruciate Ligament (ACL) injuries are common injuries within sports. While these are common injuries, they are also feared injuries due to the surgical procedure, the long period of rehabilitation and the uncertainty of returning to sport (RTS), with kinesiophobia being one of the main causes that prevent athletes from this RTS. The objective of this systematic review is to verify which strategies can be used and which are effective in reducing kinesiophobia during the rehabilitation of anterior cruciate ligament injuries. A secondary objective is to analyze whether any of these strategies can facilitate RTS. Methods This is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. The search was carried out in the databases: PubMed (MEDLINE), Web of Science, ScienceDirect (Elsevier) and PsycINFO (APA) and was closed on December 16, 2023 with the following terms: "Anterior Cruciate Ligament" AND “ACL injur *” OR kinesiophobia OR Fear OR Psychological AND Therapy OR Rehabilitation OR Treatment. Results Eight clinical trials were selected for data analysis. In total, 396 individuals were evaluated with a mean age of 16.0±5.0 years to 35.0±11.9 years. The most used questionnaires to assess kinesiophobia were the Tampa Scale for Kinesiophobia (TSK) and the Anterior Cruciate Ligament – Return to Sport Index (ACL-RSI). Most studies showed the effectiveness of interventions in reducing kinesiophobia. Other outcomes were also evaluated and were found to be favorable for the intervention groups (IG), compared to the control groups (CG). Conclusion Education about treatment, progressive physical training and variation in the post anterior cruciate ligament reconstruction rehabilitation process prove to be an effective alternative in reducing kinesiophobia and improving knee function.

Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury

PurposeTo investigate the influence of the timing of ACL reconstruction (ACLR) on patient-reported outcomes, comparing those with and without concomitant medial collateral ligament (MCL) injury. MethodsThis study included patients who underwent ACLR between September 2015 and October 2020. Inclusion criteria required patients to have preoperative and postoperative patient-reported outcome measures (PROMs) and a follow-up period of at least 2 years. Patients who sustained a grade 2 or 3 MCL injury with an ACL tear were compared to patients with no MCL injury as a control. All patients underwent ACL reconstruction using either bone-tendon-bone (BTB) autograft or BTB Allograft. Patient-reported outcomes (International Knee Documentation Committee (IKDC), Lysholm, and Knee Osteoarthritis and Score (KOOS)) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted. ResultsA total of 253 eligible patients with 2-year outcomes were enrolled. Combined ACL/MCL injury had lower IKDC (β=-6.1 vs β=-8.3, p=0.003), KOOS QOL (β=-9.3 vs β=-11, p=0.004), and KOOS Sport (β=-12 vs β=-13 , p=0.08) if performed after 6 weeks from index injury. Isolated ACL injuries showed lower KOOS ADL (β=-2.4, p=0.045) if surgery performed between 3-6 months. For combined ACL/MCL injury, autograft (compared to allograft) was found to have worse IKDC (β=-11 (-18, -4.2), p=0.002), Lysholm (β=-9.2 (-15, -3.1), p=0.004), KOOS QOL(β=-11 (-20, -1.6), p=0.023), KOOS Pain (β=-5.1 (-10, -0.03), p=0.049), KOOS Symptoms (β=-7.6 (-10, -0.03), p=0.02), and KOOS Sports (β=-21 (-32, -10), p=<0.001). ConclusionPatients undergoing ACL reconstruction with a grade 2 or 3 MCL injury have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts. Level of EvidenceLevel III Retrospective Cohort Study

Stress fracture in athletes after reconstruction of the anterior cruciate ligament of the knee – case reports and literature review

Objectives We purpose to report two cases of stress fractures in amateur athletes after anterior cruciate ligament reconstruction (ACLR) and review literature data. Methods Case Presentation: The first case involved a 30-year-old male, who underwent ACLR with hamstring autograft. Post-surgery, he recovered well and returned to sports after 9 months. However, he later experienced pain, swelling, and reduced joint motion, revealing a low-risk, grade III stress fracture in the postero-medial region of the proximal tibia. The second case featured a 34-year-old male with ACL injury, successfully treated with ACLR using hamstring autograft. Despite a smooth recovery, he developed pain and swelling, uncovering a low-risk, grade III stress fracture in the postero-medial proximal tibia during follow-up examinations. Results Two rare stress fracture cases in the tibial plateau post-ACLR are reported in amateur athletes. Following initial recovery, both experienced pain, swelling, and reduced knee motion. MRI revealed low-risk stress fractures in the postero-medial proximal tibia (grade III). Management involved a two-phase protocol: pain control, activity modification, and physiotherapy (1); gradual return to sports with predisposing factor correction (2). The paper discusses the rarity of such fractures in healthy athletes, emphasizing tibial tunnel positioning and biomechanical factors. Genetic susceptibility to stress fractures is considered. Evaluation of acutely painful knees post-ACLR should include stress fracture assessment, emphasizing early MRI diagnosis and established management principles. Conclusion In conclusion, stress fractures in the proximal tibia following ACLR are infrequent, especially in athletic individuals, highlighting the need for continued research into contributing biomechanical factors, optimal tunnel positioning, and genetic influences. Management protocols involve early detection through MRI and a phased approach to rehabilitation, emphasizing the significance of individualized patient care.

Microsoft CoPilot Provides More Accurate and Reliable Information About ACL Injury and Repair than Chat GPT and Google Gemini; However, No Resource Was Overall the Best

Microsoft CoPilot Provides More Accurate and Reliable Information About ACL Injury and Repair than Chat GPT and Google Gemini; However, No Resource Was Overall the Best

Effectiveness of Treatment with Stem Cells in Injuries of the Anterior Cruciate Ligament: A Systematic Review

Objectives Due to the lack of consensus, the objective of this systematic review was to describe the results in the literature with greater evidence on the effectiveness of stem cell (SC) treatment in ACL injuries, understanding their indications and updates on recommendation level. Methods A systematic review was conducted in accordance with PRISMA guidelines. Two reviewers independently carried out a search with the same descriptors in the MEDLINE, EMBASE and Web of Science databases, for studies published up to 2023. The following descriptors were used: Stem cell; knee injuries; Anterior Cruciate Ligament; Treatment. The following filters were used to reach the expected final result: “Randomized Controlled Trial; “Randomized Clinical Trial”; “Meta-Analysis”; “Systematic Reviews”; “Pragmatic Clinical Trial”. Results A total of 11 studies met all inclusion/exclusion criteria and were included in this review. There was a very strong correlation between the searches of the two researchers (k=0.841). In the included clinical trials, patients were evaluated primarily based on patient-reported outcome scores, and validated instruments. Clinical trials demonstrated results, but not significantly, post-injection in patients who received SC compared to patients who received hyaluronic acid (HA). There were no significant differences in post-injection outcome scores when comparing patients with and without SC use. Conclusion The clinical application of stem cells for the treatment of ACL injuries may be a good adjunctive treatment option. However, published clinical studies to date have not identified a significant difference, even with apparent clinical improvement.

Lateral Meniscus Allograft Transplant With Capsulodesis and an Osteochondral Allograft to the Lateral Femoral Condyle

Background: Anterior cruciate ligament (ACL) injuries frequently present with lateral meniscal injuries, and when irreparable, this may lead to meniscectomy, increasing the risk for osteoarthritis. Lateral meniscal allograft transplant (LMAT) can restore knee function and proper contact pressures. When combined with osteochondral allograft (OCA) for chondral defects, results are highly positive. Indications: LMAT is indicated in relatively young patients (&lt;50 years of age) with a symptomatic, meniscus-deficient knee that has failed conservative treatment. The knee must be stable, without articular cartilage damage that cannot be repaired, and patients should be able to adhere to postoperative rehabilitation and future care. Indications for OCA include young, active patients with posttraumatic osteochondral defects, osteonecrosis, osteochondritis dissecans, large focal defects, previous cartilage repair failure, or patellofemoral joint cartilage lesions. Technique Description: After a diagnostic arthroscopy is performed and concomitant injuries are ruled out, the lateral meniscal tissue is debrided to a 1- to 2-mm rim for the recipient site preparation. Tibial sockets for root fixation are created using tibial guides and passing sutures are placed. A capsulodesis is performed to reduce meniscal extrusion by securing the lateral capsule through a transtibial tunnel to the anteromedial tibial cortex with high-strength sutures. A meniscal allograft, prepared with bone plugs, is introduced through an enlarged anterolateral portal. After it is accurately positioned, it is stabilized using Fast-Fix Flex devices and circumferential sutures. The bone plug sutures are then fixed through the tibial tunnels to the anteromedial tibial cortex with a button. The large cartilage defect is addressed with an OCA transplant, involving defect measurement, careful reaming, and press-fit insertion of a donor plug, ensuring congruent articulation. Results: Patients can expect improved clinical outcomes and high patient satisfaction with LMAT and concomitant OCA. The use of bone plugs minimizes soft tissue dissection while achieving solid osseous fixation. Discussion/Conclusions: LMAT with OCA leads to restored contact pressures to near-physiological levels, a high patient satisfaction of over 85%, and mean allograft survival of 16 years. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

From Fear to Resilience: A Scoping Review of Psychological Components in Anterior Cruciate Ligament Rehabilitation.

Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. Scoping review. A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development.